Draining bodily fluid

ABSTRACT

A urethral prosthesis with prostatic and bulbar segments connected by two types of ties allows the prosthesis to assume at least two configurations different with inter-segmental distances adapted to situations where the patient either has or does not have normal control of the external sphincter. This is particularly useful for a patient undergoing an anesthetic procedure that affects the external sphincter muscles. When the muscles are anesthetized, the prosthesis may provide constant urine voiding, and when the anesthetic effects wear off, the prosthesis may assume a different configuration to allow the sphincter to reassert control over urinary voiding.

CROSS-REFERENCE TO RELATED APPLICATION

This is a continuation of and claims priority to a prior U.S. patentapplication Ser. No. 09/858,789, filed on May 16, 2001 now U.S. Pat. No.6,494,855.

TECHNICAL FIELD

The invention generally involves urethral prostheses and related methodsfor draining bodily fluid from a patient.

BACKGROUND INFORMATION

Normal voiding of urine can be controlled through a patient's sphinctermuscles, including voluntary control through the external sphincter.When functions of sphincter muscles are temporarily compromised, forexample, due to anesthesia, a patient's control over normal urinevoiding is likewise temporarily compromised.

Medical professionals that treat patients undergoing an anestheticprocedure currently have limited options for addressing urinaryretention during and after the procedure. These include the use of aFoley catheter. In many cases, because post-operation assistance invoiding is needed (such as in the case of a urethral stenosis), theFoley catheter will remain in the patient's urethra. However, there aredisadvantages in the use of a Foley catheter after an anestheticprocedure. For example, because the Foley catheter provides constantdrainage through the urethra by maintaining the internal sphincter open,it does not allow the patient to control voiding even after the patientrecovers normal sphincter function. This has brought inconvenience andemotional distress to the patient. Also, the Foley catheter extendsoutside the body, again causing the patient emotional distress anddiscomfort. The extracorporeal portion of the Foley catheter alsosubjects the patient to risks of infection.

SUMMARY OF THE INVENTION

It is an object of the invention to provide a patient (e.g., a humanmale) with assisted urinary voiding, while also allowing the patient tocontrol the external sphincter muscle as it regains functionality, suchas after an anesthetic procedure. It is another object of the inventionto provide the patient with such assisted and controllable releasewithout the discomfort, emotional distress, or infection ratesassociated with conventional treatments.

In one aspect, the invention relates to a urethral prosthesis capable ofadopting at least two configurations depending on the functioning ornon-functioning of a patient's external sphincter muscles. When theexternal sphincter muscles are not functioning or malfunctioning, theprosthesis may assume a compact configuration (locked or tied), and beplaced in the urethra and adjacent the external sphincter muscles toprovide constant drainage. When the external sphincter regains itsfunction, the prosthesis may be transformed into an extendedconfiguration. Reconfiguration will allow reposition of portions of theprosthesis away from the external sphincter muscles so that the musclescan contract and control urinary voiding.

An embodiment in accordance with these aspects of the invention includesa first segment, a second segment, and an adjustable tie connecting thetwo segments. The first segment includes a distal portion with at leastone distal opening for receiving fluids such as urine, and a proximalportion with at least one proximal opening. A lumen extends from the atleast one distal opening to the at least one proximal opening. Thesecond segment similarly includes a distal portion, a proximal portion,and a lumen extending from at least one distal opening to at least oneproximal opening. The connecting tie is adjustable with a variety ofinter-segmental lengths; such adjustments result in a variety ofcorresponding distances between the segments. The tie may be adjusted toshorten the distance between the segments so that the proximal portionof the first segment directly contacts the distal portion of the secondsegment. This “compact” configuration of the prosthesis is useful whenpatient's external sphincter is malfunctioning because the sphinctermuscles may be held open by the prosthesis, resulting in constantdrainage. When the external sphincter regains its function and voluntarycontrol over the assisted voiding is desired, the prosthesis can beadjusted to assume an “extended” configuration. To do so, theinter-segmental distance is lengthened to allow insertion of an object,such as a portion of the external sphincter, which intercepts fluidcommunication between the lumens of the two segments. Under thisextended configuration, the prosthesis permits functional sphinctermuscles to contract and block, or extend and open fluid communicationbetween the lumens, and therefore, achieving voluntary control overassisted urine voiding.

The adjustable tie in this embodiment may comprise a thread withtwo-ends. The ends may be connected or unconnected. In a preferredembodiment, the thread forms at least one loop between the proximalportion of the first segment and the distal portion of the secondsegment. In a particularly preferred embodiment, the thread forms aone-and-a half loop between the segments. The ends of the thread may beknotted together. Upon pulling the knot in a substantially proximaldirection, the tie tightens the connection between the two segments,i.e., it shortens the inter-segmental distance.

The prosthesis, in accordance with another aspect of the invention, mayfurther include a second tie connecting the proximal portion of thefirst segment and the distal portion of the second segment. This secondtie has a pre-determined inter-segmental length between the first andthe second segments of the prosthesis. The pre-determinedinter-segmental length in turn sets the maximum value for the distancebetween the first and the second segments of the prosthesis. Such amaximum inter-segmental distance may be sufficient for the insertion ofat least a portion of the functional external sphincter to effectvoluntary control over fluid drainage. To reach this maximuminter-segmental distance, a retrieval piece may be connected to theproximal portion of the second segment. This retrieval piece may be athread that can be pulled upon to help adjust the distance between theprosthetic segments, e.g., by pulling substantially away from the firstprosthetic segment. Furthermore, a third segment may be removablyconnected to the proximal portion of the second segment. The thirdsegment includes a distal portion, a proximal portion, and a lumenextending from at least one distal opening to at least one proximalopening. Fluid flowing from the lumens of the first and second segmentcan be relayed through the lumen of the third segment and emptied into adrainage bag connected to the proximal portion of the third segment.

An embodiment according to another aspect of the invention includes afirst and a second segments similar to the ones described above. Atleast two ties connect the segments. The first tie engages the twosegments by holding the two segments close enough to allow fluidcommunication between the lumens of the segments. In a preferredembodiment, the first tie holds the proximal portion of the firstsegment in direct contact with the distal portion of the second segment.The second tie connects the two prosthetic segments together at aninter-segmental distance upon disengagement of the first tie. Thisinter-segmental distance may be long enough to permit bodily control offluid communication between the tubular lumens (e.g., insertion ofportions of a sphincter muscle). Again, a retrieval piece may beconnected to the proximal portion of the second segment. This retrievalpiece may be a thread that can be pulled upon to help increase thedistance between the prosthetic segments. Furthermore, a third segmentwith a lumen may be removably connected to the proximal portion of thesecond segment. Again, fluid flowing from the lumens of the first andsecond segment can be relayed through the lumen of the third segment andemptied into a further connected drainage bag.

Embodiments of the invention may include additional features. Forinstance, the first segment may incorporate an inflatable balloon. Theballoon may be used for proper placement of the prosthesis. The distalportion of the first segment may further comprise a coudé tip. The firstand second tubular segments are preferably made of a biocompatiblematerial, such as silicone.

A method is provided for draining bodily fluid from a patient. Aprosthesis having two connected segments is inserted into the urethra ofa patient, then the distance between the segments is adjusted inresponse to sphincter functionality. When the patient has temporarilylost his sphincter function, the distance between the two segments maybe shortened to allow fluid communication between the lumens of theprosthetic segments. When the patient regains sphincter function, thetwo segments of the prosthesis can be adjusted further apart to allowthe sphincter muscles to come in between the two segments. A prosthesiswith an adjustable tie as described above is useful for these purposes.The prosthesis may include a retrieval piece connected to the secondsegment. Pulling the retrieval piece substantially away from the firstsegment may help lengthen the inter-segmental distance, while pullingboth ends of the adjustable tie shortens the inter-segmental distance.Furthermore, a second tie may be also provided to connect the proximalportion of the first segment with the distal portion of the secondsegment. The second tie connects the two segments at a distance fromeach other, limited by a pre-determined length. This pre-determinedinter-segmental distance may be long enough to allow the patient'ssphincter muscles to come in between the two segments and controlvoiding.

Another method is provided for draining bodily fluid from a patient. Aprosthesis having two segments is inserted into the urethra of apatient, and the two segments are connected by at least two ties. Thefirst tie engages the two segments by holding the two segments closeenough to allow fluid communication between the lumens of the segments.The second tie has a longer inter-segmental length. When the first tieis engaged, constant drainage is provided. However, when sphinctercontrol over urine voiding is desired, the first tie is disengaged fromthe prosthesis and/or removed from the urethra while at least a portionof the prosthesis remains in the urethra. And the second segment may bepulled away from the first segment through a retrieval piece attached tothe second segment, increasing the inter-segmental distance. Because thefirst tie is disengaged, only the second tie is holding the tubularsegments together, and its inter-segmental length determines thedistance between the prosthetic segments. This distance may be longenough for the sphincter muscles to assert control over fluidcommunication between the lumens.

The foregoing and other objects, aspects, features, and advantages ofthe invention will become more apparent from the following descriptionincluding drawings and from the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings, like reference characters generally refer to the sameparts throughout the different views. Also, the drawings are notnecessarily to scale, emphasis instead generally being placed uponillustrating the principles of the invention.

FIG. 1 is a schematic view of one embodiment of a prosthesis accordingto the invention.

FIG. 2 a illustrates the prosthesis of FIG. 1 in a first and compactconfiguration inside the urethra of a patient.

FIG. 2 b illustrates the prosthesis of FIG. 1 in a second and extendedconfiguration inside the urethra of a patient.

FIG. 3 illustrates certain features of one disclosed embodiment of aurethral prosthesis according to the invention.

FIG. 4 illustrates a method of using some of the features shown in FIG.3 to assist placement of a urethral prosthesis inside a patient'surethra.

FIG. 5 shows a first and compact configuration of another embodiment ofa prosthesis according to the invention.

FIG. 6 shows a second and extended configuration of the prosthesis ofFIG. 5.

FIG. 7 illustrates an embodiment of a part of the prosthesis shown inFIG. 5.

DESCRIPTION

The invention involves a urethral prosthesis for providing relief ofurinary retention, and to related methods. Specifically, the inventionprovides devices and methods for assisting urinary release underdifferent physiological conditions, namely, the functioning ornonfunctioning of a patient's sphincter muscles in relation tocontrolling urinary release. The invention provides prostheses that eachhas at least two configurations adapted for the different conditions ofthe sphincter muscles.

An embodiment of a urethral prosthesis of the invention for use intreating urinary retention is illustrated in FIG. 1. A prosthesis 9includes a first segment 10 and a second segment 20, connected by atleast one adjustable tie 5. Both segments may assume a variety ofshapes, such as cylindrical, conical, or a combination of variousshapes, formed by an outer surface and a lumen surface that may besmooth, ridged or pleated. The segments may have cross sections that areof any shape capable of maintaining an orifice open, including but notlimited to the following geometric forms: circular, oval, elliptical, orcrescent. Each segment's cross section may further change through itslength in terms of size or shape. The segments 10 and 20 may be composedof any biocompatible material, such as silicone, PTFE, polyurethane, andso on. The first tubular segment 10 has a distal portion 11 and aproximal portion 19, and is sometimes termed the “prostatic segment” asit is designed to reside in the prostatic section of the urethra whenplaced properly in the urethra. The distal direction, as used in thisapplication, is from the perspective of an operator, and therefore, whenthe prosthesis is inserted into the urethra of a patient, its distalportion points into the patient's body. The distal portion 11 of thefirst segment 10 may be straight, rounded, or may assume the shape of acoudé tip (a closed and curved tip, e.g., with a bent of about 40 degreeangle) for ease of placement inside the urethra. A coudé tip is wellknown in the art, and is described in literatures such as U.S. Pat. No.4,292,270 to Hannah et al., incorporated herein by reference. The distalportion 11 has at least one opening 2 for receiving bodily fluids suchas urine once inserted into the urethra or further up into the bladder.The opening 2 may be located at the distal tip or any other part of thedistal portion 11 as long as the opening 2 can receive urine onceproperly positioned. A proximal opening 42 is located at the proximalportion 19, preferably the proximal end. A lumen extends from the distalopening 2 to the proximal opening 42.

The second segment 20 is sometimes termed the “bulbar segment” as it isdesigned to reside in the bulbar section of the urethra when theprosthesis 9 is placed properly in the patient's urethra. It also has adistal portion 21 and a proximal portion 29. A lumen also extendsthrough the second segment 20 from a distal opening 46 in the distalportion 21, preferably at the distal end, to a proximal opening 48 inthe proximal portion, preferably at the proximal end.

The adjustable tie 5 connects the proximal portion 19 of the segment 10with the distal portion 21 of the segment 20. The tie 5 may be a thread,a ribbon, a cord, a wire, a tape, a line, or the like, that engages,unites, links or holds the two prosthetic segments together. The tie 5can be made of strands of a polymeric material, of silicone, metal,plastic, or rubber. The tie 5 may also be braided or a monofilament. Byadjusting the tie 5, an inter-segmental distance 4 between the proximalportion 19 of segment 10 and the distal portion 21 of segment 20 can bevaried. In one embodiment, the adjustable tie 5 is a thread or amedical-grade suture wire that has two ends 6 and 7. The two ends may betied together or otherwise connected, or not connected at all. The tie 5may be adjusted through a variety of mechanisms. FIG. 1 illustrates onepossible mechanism where the tie 5 forms at least one complete loopbetween portion 19 and portion 21. More specifically, the tie 5 shown inFIG. 1 forms a one-and-half loop as the two ends 6 and 7 are notconnected here. The tie 5 may be of a sufficient length that both ends 6and 7 extend outside the patient's body when the prosthesis is in use.If the ends 6 and 7 are connected, the tie 5 forms two loops ofdiffering sizes between the portion 19 and portion 21. The smaller loop14 controls the inter-segmental distance 4 and the larger loop 85 may bepartly outside a patient's body for extracorporeal manipulation duringuse.

In the particular embodiment illustrated in FIG. 1 where the two endsare not connected, pulling both ends 6 and 7 will shrink the smallerloop 14 connecting portion 19 and portion 21, effectively shortening theinter-segmental distance 4. When the two ends are connected at a knot,the inter-segmental distance 4 can similarly be shortened by pulling theknot or both sides of the knot toward the knot. In a preferred compactconfiguration, the adjustable tie 5 is tightened to its foremost, andthe proximal portion of the first segment directly contacts the distalportion of the second segment. The two lumens are in close alignment andthe inter-segmental distance 4 essentially becomes null. Theinter-segmental distance 4 can also be lengthened. One mechanism tolengthen the distance 4 is shown in FIG. 1, in which at least oneretrieval piece 25 is attached to segment 20, preferably to its proximalportion 29, and the smaller loop 14 of the tie 5 is enlarged by pullingthe retrieval piece 25 substantially away from the first segment 10. Theretrieval piece 25 may be a thread, a ribbon, a wire, a tape, a suture,or the like, and may be made of similar material as the adjustable tie5.

At least one second tie 18 may also connect the proximal portion 19 ofthe segment 10 and the distal portion 21 of the segment 20. Like theadjustable tie 5, the second tie 18 may be a thread, a ribbon, a cord, awire, a tape, a line, or the like, that engages, unites, links or holdsthe two prosthetic segments together. The second tie 18 may also be madeof similar materials as the tie 5. The second tie 18 has apre-determined inter-segmental length, i.e., the length of the secondtie 18 between the two prosthetic segments, once the second tie 18 isfully extended, is fixed. In the particular embodiment shown in FIG. 1,the second tie 18 is fixedly fastened to the first segment 10 at point31, and to the second segment 20 at point 32. Because the second tie 18is fixedly fastened at both ends in this case, its length between thefirst and second prosthetic segments 10 and 20, i.e., itsinter-segmental length, is pre-determined. When the second tie 18 isfully extended, its inter-segmental length becomes the inter-segmentaldistance 4. In the particular embodiment shown in FIG. 1, as the segment20 is pulled away from the segment 10 by the retrieval piece 25, theinter-segmental distance 4 gradually increases until stopped by afully-extended second tie 18. Therefore, the inter-segmental length ofthe second tie 18 sets the maximum value for the inter-segmentaldistance 4. However, the invention also contemplates using otherstructures known to a skilled artisan to set the maximum value of theinter-segmental distance 4. One example is to use a closed loop betweenthe segments 10 and 20 as shown in FIG. 6 in which the loop engages thetwo prosthetic segments at points 31 and 32 and the second tie 44 may beable to slide through the points 31 and 32. There may also be multipleadjustable ties 5 and multiple second ties 18 in a prosthesis 9connecting the two segments 10 and 20.

FIGS. 2 a–2 b illustrate how the embodiment of FIG. 1 can be used toassist urinary voiding. The prosthesis 9 is inserted, through the penileurethra, further up into the urethra of a patient, until the distalportion 11 of the prostatic segment 10 is disposed in the bladder 50where the distal opening 2 can receive urine. Proper positioning of theprosthesis can be confirmed through a cystoscope or other means, one ofwhich will be discussed later in association with FIGS. 3–4. Onceproperly positioned, a portion of the prostatic segment 10 should beinside the prostatic urethra, which is adjacent to a prostate 60. Theconnection between the prostatic segment 10 and the bulbar segment 20should be adjacent to an external urinary sphincter 70. When normalsphincter function is compromised, such as when the patient is underanesthesia, the inter-segmental distance 4 between segments 10 and 20 isshortened, through ways described in association with FIG. 1. Asparticularly shown in FIG. 2 a, the adjustable tie 5 connects the firstand second segments 10 and 20 of the prosthesis 9 in two loops, as thetwo ends of the tie 5 are connected at a knot 16. Upon pulling the knot16 substantially away from the first segment 10, the smaller loop formedby tie 5 gets tightened, bringing the two segments close enough to allowconstant fluid communication between their lumens. Under this compactconfiguration, the prosthesis holds the urethra and the externalsphincter muscles 70 open, thereby providing constant urine drainagethrough the aligned lumens.

When the patient regains voluntary control over the external sphincter70, such as when the effects of anesthesia wears off, an extendedconfiguration of the prosthesis may be used to allow voluntary controlover urine voiding. As shown in FIG. 2 b, the inter-segmental distance 4between the prostatic segment 10 and bulbar segment 20 is lengthened,allowing the insertion of the external sphincter 70. If the prosthesis 9is in the compact configuration depicted in FIG. 2 a, an operator maytransform the prosthesis 9 into an extended configuration by increasingthe distance between the segments 10 and 20. The operator may pull theretrieval piece 25, attached to the proximal portion of the bulbarsegment 20, substantially away from the prostatic segment 10, untilstopped by the second tie 18. In this case, the inter-segmental distance4 increases toward its maximum value set by the second tie 18 thatconnects the two segments. Since the extended configuration does notrely on the adjustable tie, the adjustable tie may be cut loose, ifknotted, and/or removed from the urethra while at least a portion of theprosthesis 9 remains inside the urethra. The removal can be achieved bysimply pulling one loose end of the adjustable tie 5 out of the urethra.The rest of the tie 5 will follow. Under this extended configuration,the distance between the prostatic segment 10 and bulbar segment 20 maybe designed to be long enough for the sphincter muscles 70 to contractbetween the two tubular segments and intercept or block fluid flowbetween the lumens of the segments 10 and 20.

The methods provided here are particularly useful for patients whoseexternal sphincter function is temporarily compromised, as in thesituation of undergoing an anesthetic procedure that affects thesphincter muscles. When the sphincter is under the influence ofanesthesia, the prosthesis may assume a compact configuration, such asone depicted in FIG. 2 a, to provide constant urine drainage. When theeffect of anesthesia is wearing off, the prosthesis may be transformedinto an extended configuration, such as one depicted in FIG. 2 b, toallow voluntary control over urine voiding through the externalsphincter. There may be a variety of reasons why the patient needs theassistance of a urinary prosthesis, such as in the situation of havingenlarged prostate 60, which obstructs the prostatic urethra. By using aprosthesis described here, the patient has the ability to controlassisted voiding as soon as his external sphincter regains its function.

A collecting device such as a condom catheter may be placed around thepatient's penis for receiving drained fluid. Since the bulbar segmenttypically does not extend outside the patient's body, and only the tiesand the retrieval piece extend that far, the risk of infection isminimized.

FIG. 3 shows some additional features that may be incorporated intovarious embodiments of the invention. The prostatic segment 10 mayinclude an inflatable balloon 1 connected through a tube 3 to aninflation source 8 that can introduce fluid (e.g., air, saline fluid)into tube 3. The tube 3 may be made of a flexible material. In theparticular embodiment shown in FIG. 3, the inflation source is a syringewith a check valve 22. Once the balloon 1 is inflated, the check valve22 (or a one-way valve) ensures that the balloon stay inflated bystopping fluid from flowing back. Other auxiliary structures, such as amalecot, that can be enlarged from outside the patient's body once theprosthesis is inserted into the urethra are also contemplated to beuseful here.

The balloon or its equivalent structure can be used to confirm properplacement of the prosthesis. Referring to FIG. 4, first, the prosthesisis inserted high up the urethra where the balloon portion most likelyenters the bladder 50. Then a volume of fluid is delivered through thetube 3 to inflate the balloon 1. And the operator pulls on the retrievalpiece 25 to withdraw the prosthesis until resistance is felt, meaningthat the inflated balloon 1 has been stopped by the bladder neck 51. Theprosthesis is designed so that the portion from the balloon to theproximal end of the prostatic segment 10 corresponds to the length ofthe prostatic urethra—once the balloon hits the bladder neck, theconnection between the prostatic segment and the bulbar segment issubstantially adjacent to the sphincter muscles 70. This means ofconfirming the proper placement of a urinary prosthesis does not requirethe use of a cystoscope, permitting a general practitioner or othermedical staff to perform this procedure.

A third tubular segment may optionally be attached proximally to thebulbar segment. The third segment contains a lumen aligned with thelumen of the bulbar segment. The third segment may be removablyconnected to the bulbar segment (e.g. using an adjustable tie similar tothe one used to connect the prostatic segment with the bulbar segment).The third segment may be long enough to extend outside the patient'sbody during use. A drainage bag may be connected to the proximal portionof the prosthesis (e.g., the proximal portion of the third segment) tocollect drained fluid.

A further embodiment of the invention is illustrated in FIGS. 5–6. Aprostatic segment 10 and a bulbar segment 20 similar to the onesdescribed earlier are connected by at least one first tie 33 and atleast one second tie 44. Both ties may be a thread, a ribbon, a cord, awire, a tape, a line or the like, that engages, unites, links or holdsthe two prosthetic segments together. The first tie 33 engages the twosegments by holding them in close proximity to allow fluid communicationbetween the lumens of the segments 10 and 20. The second tie 44 connectsthe two segments with a pre-determined inter-segmental length. In apreferred embodiment, the first tie 33 holds the proximal portion 19 ofthe segment 10 in direct contact with the distal portion 21 of thesegment 20. The second tie 44 may be fixedly fastened, at both ends, tothe prosthesis, as shown in FIGS. 5–6. Or, as also shown in FIG. 6, thesecond tie 44 may be a closed loop between the segments 10 and 20, andat points 31 and 32 where the second tie 44 engages the prosthesis, thesecond tie 44 may be able to slide through the points 31 and 32. If thefirst tie 33 is disengaged from the prosthesis, as shown in FIG. 6, thesegment 10 is connected to the segment 20 at a longer inter-segmentaldistance that is now limited by the second tie 44.

FIG. 7 illustrates the details of a preferred embodiment of the firsttie 33 shown in FIG. 5. The first tie 33 forms a closed loop between theprostatic segment 10 and the bulbar segment 20. At junction 66, a tapeportion 35 of the first tie 33 extends out. The junction 66 can adopt avariety of geometric shapes. As shown in FIG. 7, the junction 66 assumesa “T” shape. Alternatively, the junction 66 can adopt a “Y” shape orother suitable shapes. Two perforated lines travel throughout the lengthof the tape portion 35, dividing the tape portion 35 into threelongitudinal sections. A middle section 37 is further connected to anactuation thread 77 at junction 66. The actuation thread 77 may be of alength that, once the prosthesis is properly positioned inside thepatient, the thread 77's end 76, which is opposite the junction 66,extends outside the patient's body. When the end 76 of the actuationthread 77 is pulled with enough strength, the perforated lines in thetape portion 35 will tear, starting from junction 66, all the way alongthe tape portion 35. Consequently, the middle section 37 is torn away,effectively disconnecting the loop formed by the first tie 33.Optionally, the tape section 35 itself may be long enough to extendoutside the patient's body during use, and once the loop of the firsttie 33 is disconnected at the junction 66 by pulling the actuation read77, the rest of the loop may be removed from the urethra by simplypulling on the rest of the tape section 35.

To drain bodily fluid from a patient, the embodiment illustrated inFIGS. 5–7 is first inserted into the urethra of a patient. Properplacement may be confirmed, for example, through the inflated balloon inthe prostatic segment. The prosthesis may be inserted in a compactconfiguration where the prostatic segment 10 and the bulbar segment 20are held close enough, by the first tie 33, to allow fluid communicationbetween the lumens of the prosthesis. In the situation where patient isunder anesthesia, the compact configuration provides constant urinarydrainage for the patient. When the effect of anesthesia wears off, andthe patient regains sphincter function, an operator can pull on theextra-corporeal end 76 of the actuation thread 77, disconnecting thefirst tie 33 at junction 66, as described above in connection with FIG.7. Once the first tie 33 is disconnected, the operator may pull on theretrieval piece 25 connected to the proximal portion 29 of the bulbarsegment 20 to further separate the two segments into an extendedconfiguration. The second tie 44 now determines the maximum length ofthe inter-segmental distance, which may be designed to allow thesphincter muscles to contract between the two prosthetic segments and tointercept or block fluid communication between the lumens of thesegments.

The invention contemplates the combination of the prosthesis asdescribed above with other auxiliary devices used during treatment orsurgical procedure of the urinary tract such as treating urinaryretention. The use of the prosthesis may be combined with an insertionsleeve, a pusher, a stylet, an endoscope, and so on. A pusher may beused to advance the prosthesis up the urethra and into the bladder. Astylet may reside within the lumens of both the prostatic segment andthe bulbar segment to maintain the overall connection between thesegments, especially in the extended configuration.

Variations, modifications, and other implementations of what isdescribed herein will occur to those of ordinary skill in the artwithout departing from the spirit and the scope of the invention asclaimed. Accordingly, the invention is to be defined not by thepreceding illustrative description but instead by the spirit and scopeof the following claims.

1. A prosthesis for insertion into a patient's urethra, comprising: (a)a first segment including a distal portion comprising a distal opening,and a proximal portion comprising a proximal opening, the first segmentdefining a lumen extending therebetween; (b) a second segment includinga distal portion comprising a distal opening, and a proximal portioncomprising a proximal opening, the second segment defining a lumenextending therebetween; (c) an operator-adjustable first tie connectingthe proximal portion of the first segment and the distal portion of thesecond segment, the first tie forming at least one loop; and (d) a fixedlength second tie connecting the proximal portion of the first segmentand the distal portion of the second segment.
 2. The prosthesis of claim1, wherein the first tie is adjustable to adopt a compact configuration,positioning the proximal portion of the first segment in direct contactwith the distal portion of the second segment.
 3. The prosthesis ofclaim 1, wherein the first tie is adjustable to adopt an extendedconfiguration, in which a distance between the first and second segmentspermits insertion of an object between the two segments such that theobject intercepts fluid communication between the lumens of the firstand second segments.
 4. The prosthesis of claim 3, wherein the distancebetween the first and second segments permits operation of an externalsphincter muscle.
 5. The prosthesis of claim 1, wherein the first tiecomprises a thread with two ends.
 6. The prosthesis of claim 5, whereinthe two ends of the thread are connected.
 7. The prosthesis of claim 6,wherein the ends of the thread are knotted together.
 8. The prosthesisof claim 6, wherein the length of the second tie sets a maximum valuefor the distance between the first and second segments.
 9. Theprosthesis of claim 8, wherein the maximum value for the distancebetween the first and second segments permits insertion of an objectbetween the two segments such that the object intercepts fluidcommunication between the lumens of the first and second segments. 10.The prosthesis of claim 9, wherein the maximum value for the distancebetween the first and second segments permits operation of an externalsphincter muscle.
 11. The prosthesis of claim 5, wherein the two ends ofthe thread are not connected.
 12. The prosthesis of claim 5, wherein thethread forms a one-and-a-half loop between the proximal portion of thefirst segment and the distal portion of the second segment.
 13. Theprosthesis of claim 1, wherein the first segment further comprises aninflatable balloon.
 14. The prosthesis of claim 1, wherein the distalportion of the first segment further comprises a coudé tip.
 15. Theprosthesis of claim 1, wherein the first and second segments comprise abiocompatible material.
 16. The prosthesis of claim 15, wherein thebiocompatible material comprises silicone.
 17. The prosthesis of claim1, further comprising a retrieval piece connected to the second segment.18. The prosthesis of claim 17, wherein the retrieval piece comprises athread.
 19. The prosthesis of claim 1, wherein the length of the secondtie is less than the length of the first tie.
 20. The prosthesis ofclaim 1, further comprising a first connection aperture located at theproximal portion of the first segment and a second connection aperturelocated at the distal portion of the second segment.
 21. The prosthesisof claim 20, wherein at least one of the first tie and the second tieconnects the proximal portion of the first segment and the distalportion of the second segment via the first and second connectionapertures.